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MONEY CHANGER TRADING ACCOUNT APPLICATION FORM

A.BUSINESS DETAILS
Name of Business : (*)
Please field name!
Postal Code : (*)
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Email :
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Business Registration Form : (*)
Please field business registration form!
Tel No 1 : (*)
Please field tel no 1!
Fax : (*)
Please field fax no!
Valid From & Till : (*)
Please field Valid From & Till!
Remittance Licence No:
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Licence Class :
Please field Licence Class!
Address : (*)
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State : (*)
Please field state!
Website :
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Registration Date : (*)
Please field
Tel No 2 :
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Money Changing Licence No : (*)
Please field Money Changing Licence No!
Licence Class: (*)
Please field Licence Class!
Valid From & Till :
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BANK
Bank :
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Bank :
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Bank :
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Bank Account No :
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Bank Account No :
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Bank Account No :
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B.DIRECTORS,SHAREHOLDERS AND BENEFICIAL OWNER(IF ANY)
Name as in IC/Passport : (*)
Please field name!
State/Country : (*)
Please field State/Country!
IC/Passport No : (*)
Please field IC/Passport No!
*Passport Expiry Date :
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Contact No : (*)
Please field Contact No!
Address : (*)
Please field address!
Postal Code : (*)
Please field Postal Code!
Position : (*)
Please field Position!
Nationality : (*)
Please field Nationality!
Date of Birth : (*)
Please field Date of Birth!
C.AUTHORISED PERSONNEL TO CONTRACT DEALS
Name as in IC/Passport : (*)
Please field name!
State/Country : (*)
Please field State/Country!
IC/Passport No : (*)
Please field IC/Passport No!
*Passport Expiry Date :
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Contact No : (*)
Please field Contact No!
Address : (*)
Please field address!
Postal Code : (*)
Please field Postal Code!
Position : (*)
Please field Position!
Nationality : (*)
Please field Nationality!
Date of Birth : (*)
Please field Date of Birth!
D.AUTHORISED PERSONNEL TO TRANSACT AT PREMISES
Name as in IC/Passport : (*)
Please field name!
State/Country : (*)
Please field State/Country!
IC/Passport No : (*)
Please field IC/Passport No!
*Passport Expiry Date :
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Contact No : (*)
Please field Contact No!
Address : (*)
Please field address!
Postal Code : (*)
Please field Postal Code!
Position : (*)
Please field Position!
Nationality : (*)
Please field Nationality!
Date of Birth : (*)
Please field Date of Birth!
E.CHECKLIST AND DECLARATION

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Name Of Person : (*)
Please fill name
Title/Position : (*)
Please fill title
IC/Passport No : (*)
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Declaration

I/We have furnished the information to the best of my/our knowledge and will duly inform the management of Metro Money Exchange Sdn Bhd if there should be any changes declared in this form and in any additional sheet(s) completed.

  Date

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Company Stamp & Authorised Signature